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<head>
    <meta http-equiv="Content-Type" content="text/html;charset=UTF-8">
    <link rel="stylesheet" href="../../css/style.css" />
    <link rel="stylesheet" href="../../css/per.css" />
    <script src="../../js/jquery-1.7.2.min.js"></script>
    <script src="../../js/myjs.js"></script>
<body>

	<br/>
    <form action="" class="personal_student_form">
        <div><span>父母姓名：</span><input type="text" name="" />（其中一个）</div>
        <div><span>联系方式：</span><input type="text" name="" /></div>
        <div><span>家庭电话：</span><input type="text" name="" /></div>
        <div><span>邮政编码：</span><input type="text" name="" /></div>
        <div><span>详细地址：</span><input type="text" name="" /></div>
        <div><span>家庭成员：</span><input type="text" name="" /></div>
        <div><span>是否家庭经济困难生：</span>
            <select class="is_poor" name="">
                <option>请选择</option>
                <option value="Y">是</option>
                <option value="N">否</option>
            </select>
            <select  class="chose_year" name="">
            <option>选择申请年份</option>
            <option>2014</option>
            <option>2013</option>
            <option>2012</option>
            <option>2011</option>
        </select>
        </div>
        <div><span>班级评估：</span>
            <select>
                <option>请选择</option>
                <option>通过</option>
                <option>未通过</option>
            </select>
        </div>
        <div><span>贫困等级：</span>
            <select>
                <option>请选择</option>
                <option>特别贫困</option>
                <option>一般贫困</option>
            </select>
        </div>
        <div><span>家庭成员详细信息：</span><textarea name=""></textarea></div>
        <div><span>家庭经济详细信息：</span><textarea name=""></textarea></div>
        <div><span class="tip"></span><input type="submit" value="保存" class="personal_submit"></div>
    </form>
</body>
</html>